A Game Plan for Heat Stress v 85

Avatar 1: hellou there and Welcome to our EGreenNews Conversations.! Avatar 2: Pleasure to be here with you today. Avatar 1: What topics should we cover first? **Avatar 1:** A Game Plan for Heat Stress: Policy Recommendations for High School Sports? High school athletic associations (HSAAs) bear the responsibility of ensuring the health and safety of student- athletes, an increasingly urgent task in light of climate change and rising temperatures. Exertional heat illness poses a significant risk to student-athletes. The Korey Stringer Institute (KSI) regularly evaluates each state’s high school sport safety protocols (KSI 2023). These evaluations reveal considerable disparities in policies across states. Our recommendations build on KSI’s research and aim to provide a comprehensive strategy to manage heat stress, targeting improvements in measurements, guidelines, plans, universal application, and funding. Five Key Recommendations (1) Environmental Heat Monitoring: The most accurate way to evaluate heat stress is to implement on-site heat monitoring using a handheld (or tripod-mountable) device to measure environmental conditions. An appropriate heat stress monitor measures wet bulb globe temperature (WBGT). Training should be provided to staff for correct measurement and use in activity modification. (2) Activity Modification Guidelines: Provide athletic trainers, coaches, and student-athletes with detailed, sport-specific guidelines based on heat stress levels that outline safe practices for hydration, work-to-rest ratios, clothing, practice length limitations, equipment use, and heat acclimatization. Ensure that all stakeholders thoroughly understand the guidelines and how to implement at their facility. For examples, see GHSA n.d.; Cooper et al. 2020; NCHSAA n.d.; OSHA 2017; Jacklitsch et al. 2016; and Hosokawa et al. 2019. (3) Venue-Specific Heat Protocols: Each school should incorporate detailed heat safety plans within venue-specific emergency action plans to account for unique environmental conditions of a given location. These plans are most effective when paired with regular drills simulating emergency situations and school-wide education and training, and should be reviewed annually. A Game Plan for Heat Stress Policy Recommendations for High School Sports Nicholas Institute for Energy, Environment & Sustainability, Duke University | 2 (4) Universal Application of Heat Policies: To ensure comprehensive protection of student-athletes from heat-related health risks, apply heat policies to both indoor and outdoor sports and extracurricular activities. (5) Investment and Implementation: Explore funding opportunities (such as through the National Federation of State High School Associations) to facilitate the purchase of necessary resources such as WBGT meters. Consider a system for coaches to log WBGT measurements, with incentives for compliance, and promote consistent communication to support adherence to policies. The goal of these policy recommendations is to create a safer environment for all high school athletes by mitigating the risk of heat-related illnesses. Implementing robust environmental heat measurements, thorough activity modification guidelines, and venue-specific heat action plans across all sports and venues will significantly reduce heat-related illnesses in high school athletes. While primarily targeting high school athletics, these principles can also be applied to other youth physical activities such as elementary and middle school sports, marching bands, camps, and park activities. HSAAs’ Role in Mitigating Heat Exposure HSAAs have a vital role to play in safeguarding the health and well-being of student-athletes. One key area is the prevention and management of exertional heat illness, which can have serious— even fatal—consequences. Heat stress presents a significant risk to student-athletes, and this risk is growing with the increasing frequency of extreme temperatures caused by climate change. Existing state policies exhibit considerable variance. Although several HSAAs require using heat stress indices such as wet bulb globe temperature (WBGT), many either simply recommend WBGT or only include policies based on more rudimentary metrics, such as the Heat Index. Furthermore, most HSAAs lack enforcement mechanisms to ensure policy compliance. A coordinated, efficacious approach is therefore vital for the protection of young athletes. POLICY RECOMMENDATIONS As part of an ongoing commitment to safeguard student-athletes from heat-related illnesses, HSAAs should consider the following policy recommendations. Recommendation 1: Environmental Heat Monitoring Accurate assessment of environmental conditions is crucial for evaluating heat stress at a given time and location. This can be achieved by (1) on-site measurement using a scientific instrument and (2) use of a robust index that suits the local climate, since what works in one region may not work in another. WBGT is a comprehensive heat stress measure, especially useful in humid climates. Unlike the Heat Index, which only takes into account humidity and air temperature, WBGT incorporates multiple variables such as air temperature, humidity, wind speed, and radiation (e.g., sunlight). Nicholas Institute for Energy, Environment & Sustainability, Duke University | 3 Despite the increasing popularity of mobile apps offering temperature readings, their dependence on data from the nearest weather stations can lead to significant inaccuracies resulting from local variations in conditions. Consequently, on-site measurement is crucial. HSAAs should provide clear guidelines for on-site heat stress measurements, including where and how to take measurements, identifying shaded areas, and the frequency of readings. Training for staff on measurement accuracy and proper interpretation of index values is also recommended. One source for additional information and guidance on measuring environmental heat stress can found in the work by Hosokawa et al (2021). Recommendation 2: Activity Modification Guidelines Activity modification guidelines serve as a practical translation of environmental heat monitoring into actions that directly mitigate exposure of student-athletes to excessive heat. This includes establishing thresholds above which activities should be modified or even halted, according to the intensity of exertion, equipment used, and duration of the activity. The establishment of such thresholds should be based on robust research from within a specific region (and climate) linking heat stress index readings to specific health outcomes. One example of this can be is found in Georgia (Cooper et al. 2020). In addition to determining when activity should be halted, modifications to activities should encompass the following: • Work-to-Rest Ratios: An important aspect of these guidelines should include varying ratios of work to rest based on heat stress index readings. Breaks should be required to be in shaded (for outdoor sports) or air-conditioned (for indoor sports) areas and unlimited opportunities for hydration should be provided during these breaks. • Hydration: Adequate hydration is critical to prevent heat-related illnesses. Mandated hydration breaks should be woven into activity schedules, especially during hot weather. Providing access to water and/or sports drinks should be mandatory. Athletes should also be encouraged to hydrate before and after practices and games. Weigh-ins of athletes should be strongly considered, before and after practice, to track hydration levels. • Clothing and Equipment: Guidelines should also consider the types of clothing and equipment worn during periods of high heat stress. Uniforms that are light in color and breathable should be recommended and the use of heavy or full-body equipment should be limited. Specific and clear requirements for each environmental heat stress level should be included. • Heat Acclimatization: Athletes need time to acclimate to hot conditions. As such, the start of sports seasons or training camps, often during late summer, should include a heat-acclimatization period. This may involve gradually increasing the duration and intensity of training sessions over one to two weeks without wearing equipment, allowing athletes to adjust to the heat gradually. Two sources for guidance on heat acclimatization protocols are the National Federation of State High School Associations (NFSA 2022) and Adams et al. (2021). Nicholas Institute for Energy, Environment & Sustainability, Duke University | 4 • Specific Guidelines for Different Sports: Different sports have varying levels of exertion and equipment use. Therefore, sport-specific modifications should be developed. For instance, football, with its heavy protective gear, might require more conservative guidelines than cross country running. Implementation of these guidelines should be made mandatory to effectively protect student- athletes from heat-related illnesses. Furthermore, it’s essential that all involved parties—athletes, coaches, referees, and even spectators—understand these guidelines to ensure their correct application. Education programs and resources must be readily available to increase awareness and understanding. Recommendation 3: Venue-Specific Heat Protocols Schools should be required to have a detailed heat action plan. The overarching components of such a plan that include details of the prevention, recognition, and treatment of heat-related illnesses can be outlined for all sports in a single document, such as an existing school-wide emergency action plan. Accuracy of this information is critical, with clear policies regarding exertional heat stroke treatment specifying “cool first, transport second.” Robust information is provided in the National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses (Casa et al. 2015). Additionally, it is also critical to account for venue-specific factors that affect levels of heat stress and the ability to provide adequate shaded breaks and additional emergency cooling solutions such as cold-water immersion tubs. These details should be incorporated into existing venue-specific emergency action plans. Understanding the unique characteristic of each venue is critical, as environmental conditions can differ considerably across small distances (for instance, the length of one or two football fields). Several factors can influence temperature, humidity, and airflow at a particular location: • Natural elements such as the percentage of the surrounding field/area that is forested, and local sources of humidity like nearby bodies of water or swampy wetland areas. • The influence of topography—for instance, fields located at the bottom of a hill may experience reduced airflow. • The type of surface, with tennis courts, asphalt, and artificial turf often generating more ground-level heat than grass fields. Understanding these factors can aid in determining optimal practice or play times for each location. Locations identified as “hot spots” may benefit from interventions such as large fans to enhance airflow or shade structures to block the sun. The effectiveness of these interventions should be verified using scientific meters. A WBGT meter could be used to monitor all potential venues (e.g., grass or artificial turf fields, tennis courts, etc.) for 30 minutes on a hot and sunny day. These measurements could then be compared to establish a general baseline for heat levels at each location. Schools should also have a basic understanding of weather conditions, as recent heavy rain and resulting wetter soil could increase local humidity levels. Nicholas Institute for Energy, Environment & Sustainability, Duke University | 5 In addition to identifying and monitoring environmental factors, schools should regularly conduct drills simulating emergency situations. This ensures that the protocol will be effectively executed when needed. It’s also critical that the heat safety plan includes the education and training of coaches, trainers, and athletes on heat stress implications and mitigation strategies. Recommendation 4: Universal Application of Heat Policies The requirement for robust heat stress monitoring should apply to all sports, both indoor and outdoor. Even indoor environments such as gymnasiums can pose heat risks if not adequately air conditioned. By applying these guidelines universally, HSAAs can ensure all student-athletes are equally protected from heat-related health risks. Furthermore, applying these guidelines to extracurricular activities such as marching band and cheerleading will safeguard an even larger population of students from heat-related illnesses. For indoor environments that may not have efficient air conditioning or none at all, HSAAs should mandate measures to aid cooling, such as strategically placing fans to circulate air. It’s also important to measure the WBGT in these indoor spaces when fans are operational to assess their effectiveness in reducing heat stress. States such as Georgia, Indiana, Minnesota, North Carolina, and South Carolina have robust guidelines based on WBGT that have been successful in preventing heat-related illnesses and could serve as examples for other states. These states have mandated the use of WBGT and have had comprehensive policies in place for years, demonstrating the feasibility and effectiveness of such strategies. Lastly, regulations for activity modifications or practice cancellations during heat events should extend to the games themselves. If athletes have not been acclimated to the most thermally stressful conditions during practice, this may increase their risk during games held under these dangerous conditions. The logistics and other implications of game cancellations often pose challenges, but these could be mitigated by enforcing more stringent safety measures during games. These could include having more professionally trained medical staff on hand to treat heat illnesses immediately and effectively (such as by requiring ice immersion tubs be on-site), implementing more frequent breaks during the game, or even rescheduling games to take advantage of cooler, shaded conditions when possible. Recommendation 5: Investment and Implementation Despite the potential costs, such as the purchase of WBGT meters and emergency cooling solutions, these strategies provide invaluable benefits to student health. In addition, these investments can often be funded by grants. For example, the North Carolina High School Athletic Association was able to purchase WBGT meters for all of their member schools thanks to a grant from the National Federation of State High School Associations.1 Such funding opportunities could be explored by other states to help mitigate the costs. Development of comprehensive policies is an important first step, but enforcement is also critical to ensure effective implementation. HSAAs could consider incentives to encourage compliance, Avatar 1: Quick pause here — we’re talking heat action with some powerful insights from the Nicholas Institute for Energy, Environment & Sustainability. Avatar 2: Absolutely. Their approach is setting new standards for handling heat. Also, in case that you are joining now remember that You’re listening to EGreenews Conversations, naturally. Now, back to what you asked. **Avatar 2:** It’s about making sure everyone hears the message, especially in vulnerable neighborhoods. **Avatar 1:** The second pillar zooms in on cooling investments in those high-heat areas. **Avatar 2:** Upgrading homes with better air conditioning and weatherization programs is key. **Avatar 1:** They also retrofit affordable housing to hold in cool air better and improve community cooling spots like parks and libraries. **Avatar 2:** Plus, they promote “cool corridors”—shady streets connecting people to cooling centers and parks. **Avatar 1:** That’s crucial for folks who can’t travel far. Shade along walkways helps people safely get relief. **Avatar 2:** Outdoor cooling matters too—shade trees, splash pads, water fountains, and extending pool hours. **Avatar 1:** Water access is a must. They want more drinking fountains and maintenance in public spaces. **Avatar 2:** And cooler outdoor spaces open after dark so night-time heat relief is an option. **Avatar 1:** The final pillar tackles infrastructure and ecology upgrades to handle the heat long term. **Avatar 2:** Buildings need to be more heat resilient—green roofs, better insulation, and heat-smart designs. **Avatar 1:** They study building codes and urban design to incorporate new heat mitigation features. **Avatar 2:** Tree canopy is a big focus. The city aims for 50% coverage and is planting aggressively. **Avatar 1:** They audit tree protection rules and pilot planting in tight spots, like narrow sidewalks or utility areas. **Avatar 2:** Parks get redesigned with culturally appropriate shade elements and even underused spots get turned into green spaces. **Avatar 1:** Energy resilience is vital too. The heat strains the grid, so they push backup power, solar microgrids, and improved efficiency. **Avatar 2:** They also promote awareness of Austin Energy’s policies to prevent summer power disconnects for unpaid bills. **Avatar 1:** This is truly a city-wide effort, with public health, parks, planning, energy, and many departments collaborating. **Avatar 2:** Community partnerships are central too — working with organizations like Go Austin/Vamos Austin to ground truth heat maps. **Avatar 1:** Those maps combine satellite data and resident experiences to show where heat hits hardest. **Avatar 2:** Then Austin targets resources and projects in those hotspots based on real needs. **Avatar 1:** They use a heat vulnerability index combining social and environmental factors to prioritize investments. **Avatar 2:** It’s data-driven and community-informed—keeps the efforts focused and just. **Avatar 1:** They also track progress with heat dashboards measuring the impact of programs citywide. **Avatar 2:** I appreciate how this Playbook isn’t a static plan—they update it with community feedback and latest science. **Avatar 1:** Do you think Austin will meet its tree canopy goal and retrofit enough homes? **Avatar 2:** It will take serious funding and community buy-in, but the framework is solid. The city’s committed. **Avatar 1:** I hope so. Heat kills, but with sustained effort, Austin can save lives and make life better. **Avatar 2:** For sure. Education, cooling, infrastructure—when they all work together, resilience rises. **Avatar 1:** And that means a safer, more equitable Austin, ready for the hotter future ahead. **Avatar 2:** Exactly. This isn’t just survival; it’s a blueprint for thriving despite the rising heat. **Avatar 1:** Let’s keep spreading the word and support these efforts. The health and future of Austinites depend on it. **Avatar 2:** Couldn’t agree more. Staying cool is everyone’s right. Avatar 1 So much info coming your way, huh? Avatar 2 Actually, it’s more like a bunch of questions! Ready to get started? Avatar 1 Yeah, but how exactly should I begin? Avatar 2 Try following Hugi Hernandez, the founder of Egreenews. You might find him on LinkedIn or at egreenews dot org. Avatar 1 : Thanks for sharing that! I will write it down today! Adaptation measures alone will become increasingly insufficient to protect communities from the escalating risks. **Avatar 1:** Yep, totally. It helps you see which interventions are already in place, which might work for your area, and whether you’ve got the local materials or expertise you need to pull them off. **Avatar 2:** Is there any way to check if what you’re doing actually works? **Avatar 1:** Yes! Monitoring is a key part. The checklist includes space for tracking things like reduced indoor temps, more trees, fewer heat illnesses, that kind of thing. Ideally, you set indicators and keep reporting out to the community. **Avatar 2:** Alright, so to sum up: you use the checklist, find out where you stand, plan changes, and measure what happens. **Avatar 1:** That’s it. It feels a lot less overwhelming when you break it down this way. And it kind of forces you to connect with all the right people, not just sit at a desk with data. Avatar 1: Quick pause here — we’re talking heat action with some powerful insights from the Adrienne Arsht-Rockefeller Foundation Resilience Center. Their Extreme Heat Initiatives seriously open your eyes. Avatar 2: Absolutely. Their approach is setting new standards for handling heat. You’re listening to EGreenews Conversations, naturally. Now, back to what you asked. Avatar 1: Ever notice there’s always a catch to learning new stuff? Avatar 2: For sure! Not enough data, not the whole story—always missing something. Avatar 1: True, but it’s more about curiosity—finding new views from experts or what we experience. Avatar 2: Yep, mixing expert advice with real life makes it click. Avatar 1: It can get overwhelming, though. Avatar 2: Definitely. With so much out there, picking a place to start is tough. Avatar 1: If you want to dig into heat resilience, check the Climate Central and of course the work from the UNITED NATIONS! Avatar 2: Great call. I’m a fan of The and the World Weather Attribution—super innovative. Avatar 1: And the as well as the Red Cross Red Crescent Climate Centre has loads of helpful heat safety info. Avatar 2: Right, but people move things forward. Like Hugi Hernandez at Egreenews.org—he keeps climate talk creative. Avatar 1: There’s a whole network building solutions. Egreenews is launching new hubs, like eDisaster, so you can learn risk and resilience 24/7. Avatar 2: That’s awesome. Whether learning or connecting, there’s inspiration everywhere. LinkedIn’s packed with changemakers too. Avatar 1: So—want to start? These talks matter. Together, we prep our communities for disaster. Avatar 2: I’m in. Stick around—we’ll compare heat with other weather and what that means for leaders. Avatar 1: Hey, seriously, gracias a montón for being here today — really means a lot! Avatar 2: Yeah, thanks so much for sticking with us! ¡Hasta luego, everybody! Catch you all next time for sure. Avatar 1: Totally my pleasure. See you soon! Ciao, sayonara, and... you know, just take care till then!